EoE Treatment Overview Symptoms and causes Diagnosis Treatment What are the treatment options for EoE? Eosinophilic oesophagitis (EoE) is a chronic disorder that can wax and wane. Currently, there is no known cure. There are various symptom management options which need to be discussed with your expert consultant in eosinophilic oesophagitis as each option has its pros and cons with a variable chance of success and may require one or more approaches i.e. drug and diet. Dietary treatments Sometimes the first dietary approach adopted by patients is often to avoid the types of food that stick. These may not actually be the foods that cause the inflammation but may just be solid types of food (meat or bread) that just get stuck and as such may be of little help in treating their condition. Elimination diets of foods that might trigger the symptoms or inflammation Although a natural method, it requires careful avoidance of 2 to 6 or more foods and repeated (up to 7 or more) endoscopies to discover the true reactivity to each food, so that a long-term plan can be reached. The common foods linked to the condition which might be excluded include Dairy, Wheat, Eggs, Soya, Rice some fish and some vegetables (legumes). During this process, careful attention to nutrition with the help of a dietitian, an expert in EoE, is essential as these diets can have a high success rate, but they can be difficult to adhere to in the long term. Elemental formula diet There is a limited place for an elemental diet (amino acid-based formula) such as Neocate or EO28 in eosinophilic oesophagitis EoE but only after failure of properly performed medical treatment and/or elimination diet. This is mainly due to the fact that it can be difficult to drink due to its palatability as such it can require a nasal gastric tube (a tube inserted from nose to stomach) in order to consume the correct amount needed for nutrition. Also, the negative impact on the quality of life when abstaining from all kind of normal eating i.e. social mental impact on the sufferer and their family must be considered. Watch our specialist dietitian recordings on diets in EoE and how to manage them. Adult diets in EoE Children and teen diets in EoE Allergy testing Many of the triggers for Eosinophilic diseases are non IgE mediated - (delayed responses) intolerances which commonly do not show on a skin prick test. However, as 50-60% of Eosinophilic Oesophagitis EoE patients have an atopic (allergic) history, holistically, it is essential to manage any identified IgE mediated - (immediate) allergies such as pollens, dust or foods etc. It is also important to note seasonal allergy reactions (hayfever/asthma) have been reported by some patients to coincide with increased EoE symptoms; further research is needed in this area. Watch presentations on Allergy in EoE - What is the connection? Dilatation An endoscopic procedure performed under sedation usually, in which a narrowing (oesophageal stricture) is stretched to make the calibre of the oesophagus wider and allow food to pass through more comfortably. It can be needed if the drugs/management is not effective and it would need to be complemented with a continuation of either a diet or drugs as above. Drug treatments Topical steroids (budesonide or fluticasone) Topical steroids have the ability to reduce the symptoms quickly in the majority of patients (up to 85% resolution of signs and symptoms 12 weeks after commencing therapy). They treat the underlying inflammation and so may prevent or treat the fibrous narrowing (oesophageal strictures) that occur in some patients with eosinophilic oesophagitis EoE. The treatment is given in the morning and last thing before bed via either an asthma style pump in which you swallow fluticasone rather than inhale or budesonide slurry which you swallow to coat the affected area. (see how to make up this thick liquid) For adults in some countries including the UK, there is also a budesonide tablet licensed and recommended, that dissolves on your tongue (oral-dispersible). This treatment is ideally given last thing before bed as a specially formulated dissolvable tablet that is held in the mouth and not swallowed so the optimal amount of the drug gradually moves to the oesophagus with normal amounts of saliva. Whichever way the budesonide or fluticosone is administered, pump spray swallowing fluticasone / budesonide slurry or tablet, it is very important that it is not washed off with liquid (drink or food) for as long as possible – preferably overnight but a minimum of 1 hour. Proton pump inhibitors PPI (Omeprazole Lansoprazole) These drugs are often used for acid-related diseases (of which EoE is not one) and they can partially reduce the symptoms and signs of inflammation on biopsy in up to 50% of patients. Read up on the latest research in EoE treatments, and join our network to stay up to date with the latest information, updates and opportunities for patients and healthcare professionals: Learn more about EoE treatment and research news Last Updated 18/4/22